Localized Prostate Cancer: Little to Gain From Early ADT

One of the most important discoveries in prostate cancer was made in 1942, when Dr. Charles Huggins found that reducing serum testosterone by removing the testicles helped reduce pain and other symptoms in men with metastatic disease. Fortunately new therapies have been developed, allowing men to avoid surgery and keep their testicles. These treatments have been given many names, including castration, hormone therapy, and most recently androgen deprivation therapy, or ADT.

Many doctors have been recommending ADT for metastatic disease, and they also have been recommending it to older or less healthy men with early-stage or localized disease, as a way to keep the cancer in check and slow its progression. A second reason for ADT’s popularity among doctors was the sizable profit they received for many years from administering the costly drugs.

Although ADT had the advantage of enabling men to avoid the side effects of surgery and radiation, it, too, caused a number of significant side effects, including decreased libido, impotence, osteoporosis, anemia, fatigue, hot flashes, diabetes, high cholesterol and triglycerides, and weight gain. Unfortunately, this treatment has been done in the absence of any good studies assessing its impact on survival or quality of life. Patients accepted it, however, because in almost all cases, the serum PSA declined, which gave them a psychological boost. Now a new study has been published that may change the way ADT is used in men with localized disease.

New Research: Inconclusive

The authors compared the 15-year outcome of more than 66,000 men over age 65 who were diagnosed with prostate cancer between 1992 and 2009. They were divided into two groups: One received ADT within 180 days of diagnosis, and the other received it after that time or never. The results showed that early ADT did not improve overall survival or the odds of dying from prostate cancer.

Unfortunately, the study has several limitations that could have affected the results:

It was not randomized, which means there could be a bias in the way the men were selected to receive or not receive the ADT.

The average ages were different in the two groups.

More men in the delayed treatment group had slow growing cancers whereas more men in the early ADT group had more aggressive cancers.

Taken together, these problems mean that the study is not conclusive. Only a randomized study can provide more definitive results.

Bottom Line on Primary ADT for Localized Prostate Cancer

Despite the limitations, patients should realize that no study has ever proven men live longer or reduce their risk of dying from prostate cancer by taking early ADT. Furthermore, receiving early ADT will subject them to the long list of side effects that can greatly reduce their quality of life. The only benefit they do receive is psychological, by feeling good as their PSA declines. However, since a drop in PSA has no long-term benefit, men should question why they would ever want to begin this therapy before it is really necessary.

The bottom line: Men with localized disease have little to gain from early ADT as their primary therapy.

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ABOUT THE AUTHOR

Gerald Chodak, MD

Author, Winning the Battle Against Prostate Cancer, Second Edition.
Utilizing his experience as both a clinician and an educator, Gerald Chodak, MD, is one of the leading experts on prostate cancer. Dr....read more